Over-the-counter (OTC) asthma inhalers can help treat—but not prevent—acute asthma attacks. While not commonly recommended for the treatment of asthma, some people still turn to them because of their convenience and price point.

These inhalers can have benefits, but there are also risks—and they are not right for everyone. This article explores the pros and cons of these medications. It also wades into the controversy surrounding Primatene Mist and Asthamanefrin and what leading health experts say about the use of over-the-counter asthma inhalers.

Types of Over-the-Counter Inhalers

The two over-the-counter asthma inhalers currently sold in American drugstores—Primatene Mist and Asthmanefrin—are similar to each other and can provide temporary relief of asthma symptoms.

These medicines are approved for use by the U.S. Food and Drug Administration (FDA) to temporarily relieve symptoms of mild intermittent asthma. This is an uncommon asthma type that’s considered the mildest form of the disease.

Primatene Mist

Primatene Mist is an over-the-counter asthma inhaler used for the relief of acute asthma symptoms. It contains a drug called epinephrine (adrenaline) that acts on the airways, causing them to dilate (widen). Epinephrine is the same drug used in EpiPen auto-injectors that are used to treat severe allergic reactions.

Primatene Mist was removed from the U.S. market in 2011 because it was manufactured with an aerosol propellant called chlorofluorocarbon (CFC) that was harmful to the ozone layer. It was later approved by the FDA in 2018 when it was manufactured with a new propellant called hydrofluoroalkane (HFA) that is used in many other asthma inhalers.

Primatene Mist is not intended for long-term use. Moreover, the FDA strongly recommends not using Primatene Mist unless you’ve been diagnosed with asthma. That’s because other conditions can cause asthma-like symptoms but need to be treated differently.

Asthmanefrin

Asthmanefrin is a CFC-free inhaler that works similarly to Primatene Mist. It contains a drug called racepinephrine that has a similar action to epinephrine but tends to be potent.

Asthmanefrin was introduced as a cost-effective bronchodilator in 2012, after the discontinuation of Primatene Mist.

Asthmanefrin is not delivered in a pressurized canister like Primatene Mist. Instead, it is sold in liquid form in a 30-count pack for use in a portable nebulizer machine. This is a device that turns liquid into a fine mist for inhalation.

This makes Asthmanefrin somewhat less convenient during an asthma attack than an HFA propellant like Primatene Mist.

As with Primatene Mist, Asthmanefrin is not intended for long-term use and should only be used after you have been diagnosed with asthma by a healthcare provider.

Benefits

Over-the-counter inhalers like Primatene Mist and Asthmanefrin have certain benefits. To many people who use them, the first is cost.

Primatene Mist currently retails for around $35 a canister. A 30-count box of Asthmanefrin retails for about the same price.

The cost of prescription inhalers varies significantly, depending on the type of inhaler. Rescue inhalers with generic drugs may cost about the same as over-the-counter inhalers. Meanwhile, brand-name rescue inhalers like Proventil (albuterol) and Xopenex (levalbuterol) are about twice as much.

Then you have maintenance inhalers, which are used regularly to prevent asthma attacks from happening. Some of them cost $300 or more.

You also save money with over-the-counter inhalers because you don’t need to see a healthcare provider to get a prescription. While that saves the cost of an office visit or co-pay, it may not be the best way to treat your asthma.

Side Effects of Over-the-Counter Inhalers

Just like prescription medications, Primatene Mist and Asthmanefrin carry a risk of side effects.

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Risks of Using an OTC Inhaler for Asthma

Self-treating any medical condition poses significant risks, including:

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With over-the-counter inhalers, there’s another real concern: They can become less effective over time, but you may not realize that and keep relying on them in a crisis situation.

If this happens and you experience frequent attacks, your lungs can begin to change and become stiffer and stiffer as scar tissues develop. Over time, this can reduce your lung capacity, leaving you weak and breathless with even moderate activity.

According to a 2017 study published in BMJ Open, people who use over-the-counter rescue inhalers are no more likely to have uncontrolled asthma than those who use prescription rescue inhalers. However, they are 70% more likely to require urgent asthma care within a year.

Conflicting Opinions

In their approval of the “new” Primatene Mist in 2018, the FDA assured the public that, as with all approved drugs, Primatene Mist underwent “a robust scientific review to ensure it can be used safely by patients.” With that said, the FDA acknowledged that only a “narrow population” of people—namely those with mild intermittent asthma—would benefit.

Many health professionals do not agree.

In fact, the American College of Asthma, Allergy & Immunology, the American Association for Respiratory Care, the American Thoracic Society, and the National Association for Medical Direction of Respiratory Care do not believe that over-the-counter inhalers of any sort are safe for the treatment of asthma.

For its part, the National Institutes of Health do not include either Primatene Mist or Asthmanefrin in its Guidelines for the Diagnosis and Management of Asthma.

Summary

There are two over-the-counter inhalers available for the treatment of asthma in the United States. They are Primatene Mist, which contains epinephrine, and Asthmanefrin, which contains a similar drug called racepinephrine.

While both are approved for use by the FDA, over-the-counter inhalers are only intended for the short-term use of already established diagnoses of mild intermittent asthma. Most major health authorities, including the American Thoracic Society, advise against their use and contend that the risks of these inhalers (including an increased likelihood of a severe attack) outweigh the benefits.

A Word From Verywell

It is important to remember that over-the-counter inhalers do not have the same proven benefits as prescription inhalers. Moreover, in the end, they may not necessarily cost less than generic inhalers like albuterol or levalbuterol.

To make an informed judgment, speak with your healthcare provider first.